Medical coding is among the most in demand
professions in the USA and around the world. If you ever had, and still have
an interest in the industry of healthcare then the best time to get started is
NOW.

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Medical Billing as a Profession

A medical biller is not a medical coder, but a medical biller might need basic
medical coding knowledge, since both disciplines are so closely related and co-dependent.

We can't discuss medical coding unless we also speak about medical
billing, so closely are these two tied in with each other. Both discipline's goal is to assure that
medical reimbursement claims are promptly processed and submitted to health insurance carriers, and the health care
provider and facility gets paid for medical services rendered.

A Medical Biller Is...

Medical billers must understand all aspects of common health care and medical insurance options,
including the different plans, carrier requirements, and state and federal regulations. It is also essential that
they are able to find and pinpoint relevant information from source documents so that all claims for care and
procedures are properly processed. As the saying goes: A medical biller is the provider's key to getting paid!" In
order for the doctor's medical practice, clinic, or hospital to prosper the medical biller must know the concept of
a clearinghouse and an A/R, and understand how to verify insurance coverage, determine eligibility, collect data,
submit all claims, avoid denials, contact patients and communicate with insurance companies to ensure the highest
possible return of revenue for their employer, or client.

Medical billing for facility-based providers is different from billing for non-facility based
providers; just like inpatient coding is different from outpatient coding. Health care provider billing involves
submitting claims for individuals, such as physicians, chiropractors, nurse practitioners, physical therapists,
podiatrists, dentists, etc.; hospital billing involves claims for inpatient services, which, in turn is different
from ambulatory emergency services for people who were treated in the ER, but not admitted to the hospital's
nursing ward.

What are Billable Health care Costs?

The biggest segment of health care cost and expenses comes in form of bandages, prostheses, devices, implants,
medications, equipment, apparatuses, and countless other items required for modern care. These items and the
services associated with them must be properly coded and billed to the patient, or their health insurance provider
for reimbursement. This also includes wound care, and hospital stays. Understanding the reason for an insurance
company's claim denial is very important.

Submitting Medical Claims

Submitting medical claims is just as diverse as any other job. The medical biller must know the claims
processing guidelines for common health care plans, such as Blue Cross/Blue Shield, Tricare, Medicare and Medicaid,
etc, and state regulations that apply. There are three basic areas for billing:

inpatient hospital

outpatient services

physician billing

This goes along with other sub-areas of specialized billing, such as for DME (durable medical equipment), and
for home health care, these are the three areas most entry level medical billers are expected to handle.

Do Medical Billers Code?

A medical biller with enough medical coding knowledge is certainly capable of verifying
that medical codes are used correctly, however, the initial medical coding process is not
necessarily their forte. Why? Because often they are not specifically trained in medical coding. If they
attempt to do it anyway and something goes wrong it can create liability for them. The medical biller's
strength lies in their knowledge of different health insurance plans, provider contracts, state rules and
regulations and getting denied claims overturned and paid when the denial was incorrect. Of course,
experienced medical billers with enough general knowledge of the medical coding process are
certainly allowed to handle the medical coding and billing process from start to finish.

Wait! Some More Words of Wisdom:Every future medical coding or medical billing professional, regardless of age or
financial situation, should thoroughly research the job market in their area to understand who is hiring (and who
is not!), to gauge what the local job market is like and what potential employer's expectations are.

Additionally, those planning to build their own medical billing
business from home MUST plan ahead even more systematically and thoroughly to get a clear understanding
of attainable short and long term goals BEFORE they jump right in. They must also understand that while there
hardly ever is completely free medical billing training (watch out for scams!) there is, indeed, reasonably
priced and good medical billing vocational training readily available.

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